Huang Jiao, Luo Lisha, Wang Yongbo, Yan Siyu, Li Xuhui, Li Binghui, Huang Qiao, Wang Yunyun, Zhang Yuanyuan, Wei Sheng, Wang Yibaina, Zeng Xiantao
Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China; Center for Evidence-Based and Translational Medicine, Wuhan University, Wuhan, 430071, China.
School of Public Health and Emergency Management, Southern University of Science and Technology, Shenzhen, 518055, China.
Environ Pollut. 2023 Nov 1;336:122434. doi: 10.1016/j.envpol.2023.122434. Epub 2023 Aug 22.
Cadmium (Cd) exposure increases the risk of chronic kidney disease (CKD). But the contribution of dietary Cd intake, the primary exposure route of Cd in humans, to the CKD burden remains to be evaluated in China. Concentrations of Cd in foods and population glomerular filtration rate (GFR) were retrieved from studies published between January 2000 and February 2023 in China. Daily food consumption in adults aged ≥35 years old was obtained from two nationwide Chinese surveys. Dietary Cd intake and its contribution rate among total Cd exposure from diet, inhalation, smoking and water were evaluated. Urinary Cd (UCd) was estimated using the toxicokinetic (TK) model based on dietary Cd intake. The effect of Cd on kidney function has been quantified with the previously published dose-response relationship between UCd and GFR. The incidence and disability-adjusted life years (DALYs) of CKD attributable to dietary Cd intake were derived considering the contribution rate of dietary Cd intake at the national and provincial levels. The national average dietary Cd intake was 0.6891 μg/kg bw/day, contributing 63.69% of total Cd exposure. The Cd exposure through foods resulted in 2.34 (95% uncertainty interval, UI: 1.54-3.40) stage 4 CKD and 0.37 (95% UI: 0.20-0.59) stage 5 CKD cases per 100,000 persons/year in mainland China, 2020. The corresponding DALYs loss associated with stage 4 and stage 5 CKD due to dietary Cd intake were 5.14 (95% UI: 3.24-7.67) and 4.78 (95% UI: 2.32-8.30) per 100,000 persons/year, together accounting for 2% of total DALYs of CKD. Greater dietary Cd intake and corresponding burden of late-stage CKD were observed in Southern areas than in Northern areas. Diet remains the primary exposure to Cd in Chinese adults. Efforts to reduce dietary Cd exposure would positively impact public health, especially in Southern provinces with high Cd exposure.
镉（Cd）暴露会增加慢性肾脏病（CKD）的风险。但在中国，饮食中镉的摄入量作为人体镉的主要暴露途径，其对CKD负担的影响仍有待评估。从2000年1月至2023年2月在中国发表的研究中获取食物中镉的浓度以及人群肾小球滤过率（GFR）。≥35岁成年人的每日食物消费量来自两项全国性的中国调查。评估了饮食中镉的摄入量及其在饮食、吸入、吸烟和水中镉总暴露量中的贡献率。基于饮食中镉的摄入量，使用毒代动力学（TK）模型估算尿镉（UCd）。镉对肾功能的影响已根据先前发表的UCd与GFR之间的剂量反应关系进行了量化。考虑到饮食中镉摄入量在国家和省级层面的贡献率，得出了因饮食中镉摄入导致的CKD发病率和伤残调整生命年（DALYs）。全国平均饮食中镉摄入量为0.6891μg/kg体重/天，占镉总暴露量的63.69%。2020年，中国大陆通过食物摄入镉导致每10万人/年有2.34例（95%不确定区间，UI：1.54 - 3.40）4期CKD病例和0.37例（95% UI：0.20 - 0.59）5期CKD病例。因饮食中镉摄入导致的4期和5期CKD相关的DALYs损失分别为每10万人/年5.14例（95% UI：3.24 - 7.67）和4.78例（95% UI：2.32 - 8.30），共占CKD总DALYs的2%。南方地区饮食中镉的摄入量和晚期CKD的相应负担高于北方地区。饮食仍然是中国成年人镉的主要暴露源。减少饮食中镉暴露的努力将对公众健康产生积极影响，尤其是在镉暴露量高的南方省份。
